Natural and Medical Miscarriage Options

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If you have lost your pregnancy, your doctor may offer you several choices of miscarriage treatment. These options include waiting for a natural miscarriage, having a D&C, or using medication to induce bleeding.

If your pregnancy loss involved a medical emergency such as a ruptured ectopic pregnancy or a hemorrhage, you may have had no choice but to have surgery. If you do have a choice in your treatment, each of your options has possible pros and cons depending on your situation and personal outlook.

Waiting for Natural Miscarriage

Early in pregnancy, a miscarriage will be very similar to a heavy, crampy menstrual period. It may start with brown spotting that changes to heavier bleeding, sometimes with large blood clots. The bleeding may last up to two weeks, but it should not be heavy for that entire time. If you are soaking through a menstrual pad in under an hour that you should go to the emergency room.

The cramps in a natural miscarriage can range from mild to very strong. Your doctor can recommend painkillers to help manage painful cramps.

Some women prefer nonsurgical miscarriage because they want to avoid checking into the hospital, or they may feel that dilation and curettage (D&C) is too invasive. Women may also want to avoid the minor risks of complications from a D&C or they may want to collect the tissue for burial. (However, during the earlier stages of pregnancy the fetus will most likely not be recognizable).

If a doctor diagnoses a miscarriage before any bleeding has started, a miscarriage may take days or even weeks to happen without intervention. Most women, 80% to 90%, will miscarry within two to six weeks without complications. Still, this can be a emotionally difficult waiting process.

If bleeding has started and a woman chooses a natural miscarriage, she should be sure to follow her practitioner’s recommendations. Most likely, these will include a follow-up appointment to make sure that everything has cleared and hCG levels have returned to zero.

Medication to Induce Miscarriage

If miscarriage bleeding has not started and you prefer to avoid a D&C, your doctor may prescribe a prostaglandin medication, such as misoprostol, to speed the process. With these medications, a miscarriage will happen in the same manner as a nonsurgical loss without medication. The only difference is that the medication speeds up the process.

Sometimes doctors use medication to treat confirmed or probable ectopic pregnancies that are not at immediate risk of rupturing. For an ectopic pregnancy, the standard medical treatment is methotrexate.

Although these medications are safe for most women, they do carry risks of hemorrhage and severe cramping. If you choose this option, your doctor will go over any warning signs that require medical attention. You should remain at home or in your doctor's care while taking the medication. Avoid traveling until your doctor evaluates you again to make sure your miscarriage is complete.

D&C for Pregnancy Loss

Most of the time, a surgical management of miscarriage will be done through a D&C. If you are having a D&C, you may need to check into the hospital and have a pre-surgical workup. Some doctors perform D&Cs in their office, so this is not always necessary.

You will get either local or general anesthesia. Your doctor will then dilate your cervix and scrape or vacuum your uterine lining. You will usually be discharged on the same day as the procedure. Your doctor will most likely give you a prescription for pain medication and a recommendation to follow up either a few days or a week or two later.

A D&C may be necessary if the miscarriage poses an immediate threat to your health. This may be the case if you are hemorrhaging or if tissue remains in your uterus after a natural miscarriage. Surgical management may be recommended for some ectopic pregnancies and late pregnancy losses.

A D&C provides the fastest closure, particularly in losses where the bleeding has not yet started. Some women may wish to avoid having a visual image of the remains of the pregnancy. A D&C can make it easier to collect tissue for chromosome analysis to rule out chromosomal abnormalities for those with recurrent losses.

Some doctors use D&C as the default medical treatment for all miscarriages. If you prefer nonsurgical management and your doctor is recommending a D&C without any clear medical need, ask your doctor if they can accommodate your wishes.

A Word From Verywell

Regardless of the management option you choose for a miscarriage (if you have a choice), be sure to seek support and lean on your family and friends in this time of grief. If you are having recurrent miscarriages, read up on possible causes and tests you may want to pursue before trying again.

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